HomeMy WebLinkAbout0211 ARROWHEAD DRIVE Op Pe
'MAY 2 2 2015
MOWN OF RNSTABLE
OFTHE, Town of Barnstable *Permit 0
P` 1 Expir nths jro issue date
Regulatory Services Fee
* anaxseABLE, +
9� 16 9 � Richard V.Scali,Director
ATED��p
Building Division
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us -
Office: 508-862-403 8 Fax: 508-790-623 0
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Q,0 Not Valid without Red X-Press Imprint
Map/parcel Number •/,
Property Address.
�aResidential Value of Work$ -��"�Gd Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address ��4_4<<f C q4 L`�
qq
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable) Email: e e Y `/ e
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
(-❑ I am a sole proprietor
`P"lam the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
R—Re-side 3 Z
(�[e-Replacement Windows/doors/sliders—Value_, 0, 3 0 (maximum.3N)#of window -
�L�� #of doors:
t
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.-
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
'Note: Property Owner must sign Property Owner Letter of Permission.
A c of the Home Improvement Contractors License&Construction Supervisors License is
e ired.
r --
1 SIGNATURE:
QAWPFILES\FORMS\building permit forms\EXPRESS.dOC
Revised 061313
Town of Barnstable
Regulatory Services
P�oF1He roiy,� Richard V.Scali,Director
Building Division
* *
* 1AENSTABLE, Tom Perry,Building Commissioner
9 MASS. g, _ -
16g9• 200 Main Street' Hyannis,MA 02601
ATFD MPS p
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
DATE:
�'- Z Z r Please Print
JOB LOCATION: ,-'// Oil—
number ; street _ village
��yy ,v� ._ ,dy
`.HOMEOWNER"' (f /C-ll4lt I y �/G CC' �� / S
tname home phone# / work phone#
CURRENT MAILING ADDRESS: -21/ 4/1-40164.-, d A d Z4
city/town state f/zip code—__
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section
109.1.1)
The undersigned"homeowner"assumes responsibility-for compliance with the State Building Code and other applicable codes,
bylaws,rules and regulations.
The undersigned"homeowne " certifies that he/she understands the Town of Barnstable Building Department minimum inspection.
procedures requireme and that he/she will comply with said procedures and requirements.
(�-' ure of Homeowner
Approval of Building Official
t
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code
Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt
from the provisions of this section (Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner
engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor
(see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness-often
results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot
proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is
ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities, many communities require,as part of the
permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page
of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in
your community.
Q:\WPFILES\FORMS\building permit formS\EXPRESS.doc
Revised 061313
1
�T
*' BARNSTABLE +
"�: ,0� Town of Barnstable
Regulatory Services
Richard V.Scali,Director
Building Division
Thomas Perry,CBO
Building Commissioner _
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
Signature of Owner Date
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
Q:',WPFILES\FORMS\building permit forms\EXPRBSS.doc
Revised 061313
--------- - - -
y'
The ConzM- orxtvealth of Massachusetts
D part me tt o,f l'ndastrial Aecidenis
Y! {` Offlce of Investigations
600 Washingtow Street
Boston,.l M 02111
n,#vkk massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Conta-actors/l t ns/' hers
Applicant Information Please Print Legibly
Nme(Bu -nm;`Organizaaonrindisidual)_ f,//f oL X-J &x e C`y
Address:-
{ City/StatelZ pc �T�iG Nov r 1 /� Ph..,-,
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer-With 4. ❑ I am a general contractor and I
6_ ❑New construction.
employees(full andlorpart:-tame).* have hired the sub-ctntractors
2.❑ I am a sole proprietor ofpartaxer-
listed on the attached sheet. 7- Remodeling
ship and lave no employees These sub-contractors have g- ❑Demolition
working for me in any.�capacity- employees and have workers'
� x 9- ❑Building addition.
[No tt orlo rs'comp_insurance comp_insurance
. ❑ tie.are a corporation and its 10_❑Electrical repairs.or additions
e ued-� officers have exercised their 11. Plumbing:repairs or additions
3;�I ant a homeowner dais all u��ark ❑ g p
myself[No workers'comp_ right of exemptioa per iGiGL i?'_❑Roof repairs
insurance required.]7 c. 1.52,§1(4),and vie have no
employees-[No workers' 13.❑Other
comp-insurance required_]
#Any applicant-&at checks box#1 rumsi also fin our the section below*showing flies vmrkers'compens tion.pahcp information_
1=ameomners who submit this:afhdm t in&cstLug they are doing all woA and tb m hire antsi&contractors nmst submit anew of davit indicating sad3-
rtCbatrscmrs rLn rb this box crust attached au aiddifionsl sheet showing the nano of the sub-contractm and state whether or not those entities;have
enVlayees. Ifthe sub-contractors have emplogeer,'they must provide their markers'comp.policy number-
Iam an employer that is prmidin,workers'cor gmusation insurance for Lary emplayees. Below is the policy rain job:site
inforinafan.
Insurance Company Name: _
Policy,4+'or Self-ins,Lit.#: - Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration Mate}.
Failure to secure coverage as required under Section.25A of MGL e- 152 can lead to the imposition o€rr,n ir,al penalties of a
fine up to$1,500.00 andlor one-year impnsonment,as well as cital penalties in the four of a STOP WORK ORDER and a fine.
of up to$250-00 a day against the violator_ Be advised that a copy of this statement may be fo�ded fis the Office of
Investigations of the DLk for insurance coverage verification-
Id-0
hereby . rider tho pmns penaltes ofpetYnq that fire irifornzat"out pi m ided above is true and correct
—Sit?ttsfiure:� �
Phone : �/ / ,. �`S � �-J
Official use onit . Do not ierite in this area,to be compie-tm. by city or tows of ciaL
City or Tomm: Permitfl.icense 4
Issuing Anthority(circle one.):
1.hoard of Health I Building Department 3.Ci ffown Clerk 4-Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:.
QUERY PERMITS : QUERY END
QUERY PERMITS
PENTAMATION----------------------------------------------------------- 10/01/97
PERMIT NUMBER 24182 PARCEL ID 270 076 211 ARROWHEAD DRIVE
PERMIT TYPE BADDI BUILDING PERMIT ADDITION
DESCRIPTION 16X25 ADDITION SEW.PT.#97-296
CONTRACTOR
PERMIT FEE 68 . 20 VARIANCE
STATUS A ACTIVE
CONSTRUCTION TYPE 434 GROUP TYPE 1
APPLICATION 07/03/1997 EXPIRATION
VALUATION 22000 . 00 DATE ISSUED 07/03/1997 COMPLETED
DEPARTMENT-----STATUS---DATE-----DEPARTMENT-----STATUS---DATE----
(N) EXT/ (P) REVIOUS/ (C) ONTRACTORS/ PR (0) PERTY/ (I) NSPECTIONS/ (H) ISTORY/
(F) EES/ (A) RCHITECTS/ (V) IOLATION/ (E) XIT
7
is
4f5
I
Engineering Dept.(3rd floor) Map _� O Parcel 0 7 Permit#
R House# / Date Issued
II 3
Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) 9�~.J-�� �� Fee
Conservation Office.(4th floor)(8:30- 9:30/1:00-2:00) 7 Z F
PI �f IHE
De `- . 19 SEPTIC SY g T.BE
INSTALLED NCE
- WIT i a
_ TOWN OF BARNSTAB1&VIR0NMEN DE AND
Building.Permit Application TOWN REGULAMON'S
Project Street Address p��' A e(?Qu), Re ADD
Village s�i.�.�1CIIJ-23;�: �"� Owl
Owner .C_ A V_LQ r.0 lR. Address V0A)
Telephone ; 6 57 yS �d 3 a
41
Permit Request � P 9Y A �lJ
First Floor 2m, 46U/ square feet Second Floor square feet
Construction Type W O
Estimated Project Cost $j O a2g,duo,
Zoning District t If e . Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ((No On Old King's Highway ❑Yes �No
Basement Type: Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) % _ ::_ Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing _ New Half: Existing New
6,k- o.of Bedrooms: Existing_ New _ 7-07-2)4—
Total Room Count(not including baths): Existing_y New 3 First Floor Room Count C/
Heat Type and Fuel: ❑Gas ❑Oil aElectric ❑Other
Central Air ❑Yes dNo g Fireplaces: Existing 0 New Existing wood/coal stove Yes No
P � g
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
None ❑Shed size
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal#W ITM I N SQTEAC.4Recorded❑
Commercial ❑Yes %J(No If yes, site plan review# -
Current Use V AUM O X) Hory\c Proposed Use VACATI A) NOm4
Builder Information DAY
Name m ►ck4AQL /' 16�M Telephone Number 6 6
Address QrS L 0W ( ( R D N O� (&AD I�J-4 License# d �
Home Improvement Contractor# /1 :7 71VI
Worker's Compensation# LU 0 A) i
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE f I g p ,7
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
/ ( cJ—
*76
FOR OFFICIAL USE ONLY < .
-PERMIT NO. V '
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE #
OWNER M
DATE OF INSPECTION:
FOUNDATIONS'
FRAME - r
INSULATION `n • q,:r lQ/
FIREPLACE r
ELECTRICAL: ROUGH FINAL
PLUMBING: RO.UIGH FINAL
GAS: ROUI �. FINAL f -
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLANNO. _
1
y I t
5CJ/NEi ..6 xz
- s L/NL Ro
fee
r=r G
v
V a ' rid
All o °
NIN
Y
Jy%
AP<�2 a V y NE/-� 0 ( �' y'
I HEREBY c� I FY `Tv>£ At-P I T I ot-J OT
�5 RsQ J rrt�u��iNS 1 N
W ITN TZE25QtL9 -Tv
FUIzTN61~ c cFY T �cT-Tt-k
o E �'�- ��� �7,o`r� �-30-97
•�4a VY+�.1 fit=S N� �A�W i T F�I�a� e.1_
DEMA.L- FLOOV HAa:a�v-v Aa e A 4,,3 15 :�� ,�7t1 l Lp i�,Gl
I Sl U1J h�3E+p AS �o a3 E ''G " oN Fll&
sC-� • 8- 19-05- PAY o cj, S U /t=-✓ G.
ff t�i.�►N t 5 J ti�p i tiJ�.Pr✓ I T �1 x' ,, ,1'7 Z9
FRj{z�o5E5 qv Lam( AtA D Is N SE
TEt1 �C-oT FLAtj tS BASao 01,4 .AN 046I?v0"D
-rAN-a cuIzvlrY -d!r ICh1_ o�cvvar-�orJ. ,4DD>z>=sue t l�4eQr�wl�r�nI�z.
OF M �iF4�6.�!-LDS
qs`�'c '�': QWIJE� _
o� EDWARD /A M.G lJ R L C/Y
vs A.
N
'L70 L.Or 774P
Ize,
Frame Far Gable Vent
Insulation R-30 Ceiling 12
6
a jab
offri Vent Trimmer
Ins la ion R-11 Walls 2x4 St 6"o.c.
14"1
6x6 Post
"1
10"Footings
2x10 Floor
_ T4 5"Lallys Joists 16"o.c. 7'4
N �
6"Walls
10,11
0 1'6 1'6 1'6 1'6 Footings
F k 6'4"4. + k 7T-5 6'¢"¢ J`
F 25' J
Cross Section Framing Detail:
41'
t5'
2 915 5'5 3'2 11
7 � 3 5 3 9�2 2 �{�-3 6 71'
BATH
O O 8'1 x 6'9
O
M MASTER BDRM
DINING 00 KITCHEN 10'4x11'4
11'8 x 13'8 9'1 x 13'8
II HALL I i
3'8 x 11'3
Double 12" Micro—Lam Beam'
o CLOSET
CLOSET
' I
0
LIVING BEDROOM BEDROOM
15'8 x 10'4 9'8 x 10'4 CLOSET 10'4 x 10'4
3'8 x 5'8
EA 2 7- -2 -2 2'- -3'2 3' l3'2 3'- -3'10 4' 3' 4,
i ft
4 4"
25'
F 16' 10' 4' 11'
Floor Plan Layout:
41'
16' 25,
:;de
51*
HATCHED WALLS SHOW I I EXISTING FOUNDATION-
NEW FOUNDATION
� I
SLAB I I SLAB
15'4 x 23'8 I I 23'8 x 23'8
I
I
LIVING AREA - - - 16 - - - � - - - - - 25' - - - - -
1025 sq ft
FOUNDATION PLAN:
r ti 2c ,
a r �, '' ..'l t a♦S s
r - - ;g /ys". I- a r i7E;��•$� �4�i e.� +r �? r: ..
r,• y
a
r
. $'` ✓fee T�om>rrrwvacueall� o��¢c�iurlolLi ,f
r..:
DEPARTMENT.OF PUBLIC SAFETY
CONSTRUCTR SUPERVISOR LICENSE
Nueber: Expires:
IIICNAEL NONTO "r
LOYEIL RD
N AEAOING, .HA 01864
F' j'�'"0'R a•ar• '�+Z S:j..°TYOgi0C TK`�ww-ty�w.�'1 Z'1�R1,-6t,vC`-..p�G.._
_�i
Tltc' Conintonwealth of Massachusetts
sr tl `i5i :
Departttu•/rt of IndustrialAccidents
Olflceall�estlgat/vns
:i• 600 Washit1,41011Street
A ." Boatofr, Mas-V. (12111 .
�-• Workers' Compensation Insurance AMdavit
�•lilii cint information • —� P1c�se 1'RiNTle�iiily";'�"��-� V �_r
name- r 1 11 1 1 lLI Al I D
c ttinn ► CA A�c�lJ\�H�`n 6�8 66V Q9B�
Co�rr24CPt7 ,
�..� , C�a 6 1 No vwNe(Z h[m e7 arts �o
I am'a'homeowner performing all wort:myself. k
I am a sole proprietor and have no one working in any capacity
[1 lam an empiover providing workers' compensation for my employees working on this job.
cnnrn ttn• name:
ulclresc
city nhnnc#•
nniic� #
incnr•tncc rn.
[1 I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below whc
the following workers' compensation polices:
cum any nntttc•
adtirccc•
cin nhnnc d•
t nniicc•�
incnrnncc ro
conirinnv nninr'
add resc-
ritt nhnnc i�•
incurnnce cn nnitcv tr
Attach addititinai sheet if necessary-7 -''""`'�•" - •r ^`�r,��~~�~' - -~� ��� •` -'w`
Faiiure to secure ctn•cracc as required under Section 3A of 11GL 152 can lead to the imposition of cnmtnai penaities of a tine up to SI.50U.UU ant
one%cars'impri+nnment:t.%veil-is civil penalties in the form 0172 STOP NVORK ORDER and it fate of 5100.00 a day against me. I understand th:.
Copy of this atatentcnt ma% be furwnrded to the OfTtce of Investigations of the DIA for coverare verification.
!do lrrreht•ccalfi tinder the prrlu and p•realties of pel jun•that fire information prodded above is true and cormcl
Si=nature
('rininamc" /l .[A�LI� fPlione'f_
official use univ do not write in this area to be completed by cin•or town official
cin or town: permittlicensc it Rtluilding Department
Licensing lluard
❑ check if immediate response is required D�eleet tmcc
�• - • �ticaith Dcpcpartmcnt
.lassacltusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation 'for their
,mployees. As quoted from the "laa an empl(tree is def incd as every person in the service of another under any
.ontract of mire, express or implied. oral or written.
,n clmpinrcr is defined as an individual. partnership, association. corporation or other legal entity, or anv 1%%,o or morc .
:c fore.=oiit�_ enuaued in a,joint enterprise. and including the legal representatives of a deceased cmplover. or the
_cciver or trustee of an individual , partnership. association or other legal entity, employing employees. Ho%vever the
\vncr of a d\\•elling house having not more than three apartments and who resides therein. or the occupant of the
\\"cllinu house of another who employs persons to do maintenance , construction or repair work on such dwelling_ hous
- oft the :arcuttds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
1GL chapter 152 section 25 also states that every state or local licensing agency sliall withhold the issuance or
neii-al of a license or permit to operate a business or to construct buildings in the commonm-calth for anl•
)plicant who has not Produced acceptable evidence of compliance with the insurance coveiabe required.
Jditionalk. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
rfornianec of public work until acceptable evidence of compliance with the insurance requirements of this chapter ha
en presented to the contracting authority.
1pficants
•ase Fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
.,PIN-in.,: company names. address and phone numbers as all affidavits may be submitted to the Department of
:istr iai .-accidents for confirmation of insurance coverage. Also be sure to si-n and elate the affidavit. ?lte
ZoVit should be returned to the city or town that the application for the permit or license is being requested.
the Department of Industrial Accidents. Should you have any questions regarding the "law' or if you are required
c:ain a workers* compensatiot; policy. please call the Department at the number listed below.
or 'towns
,se be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
affidavit for you to fill out in the event the Office of Investi?ations has to contact you regarding the applicant. Pleas
ure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
Department by mail or FAX unless other arrangements have been made.
Office of Investi=ations would like to thank you in advance for you cooperation and should you have any questions.
.se do not hesitate to Live us a c-211.
Department's address. telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents r i
-44 Office of Investigations
600 Washinbton Street
Boston,Ma. 02111
fax #: (617) 727-7749
phone #: (6I7) 7274900 ext. 406, 409 or 375
d,tHe .
. The Town of Barnstable
Department of Health Safety and Environmental Services
Building Division
� g
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph CrossenB
Fax: 508-790-6230 uilding Commissi
For office use only
Permit no.__
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization,
conversion, improvement, removal, demolition, or construction of an addition to any pre-existing
owner occupied building containing at least one but not more than four dwelling units or to
structures which are adjacent to such residence or building be done by registered contractors, with
certain exceptions,along with other requirements.
,_Type of Wark•l
01TI o A) Est. CoJ a!O, oo 0
Address of Work: all A 2 ro wH e m)
Owner's Name 04 A IN e,.e Gu
Date of Permit Applications G 4 4-7
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job -
Job under S1,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of t7,�
G / 7 7(1U
Dat d I Contractor Name Registration No.
OR